Healthcare Provider Details

I. General information

NPI: 1477509610
Provider Name (Legal Business Name): HAROLD E RUTILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W HILL RD
FLINT MI
48507-4733
US

IV. Provider business mailing address

13031 OLD BILMAR LN
GRAND BLANC MI
48439-1939
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-8888
  • Fax: 810-232-9090
Mailing address:
  • Phone: 810-232-8888
  • Fax: 810-232-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301059051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: